Influence of Cardiorespiratory Fitness on Mortality among Men with and without Diabetes and Cardiovascular Disease in the Veterans Exercise Testing Study
Abstract Number: 1000-P
Authors: BRIAN EMERSON, PAUL MCAULEY, JONATHAN MYERS, RICARDO OLIVEIRA, KHIN CHAN, VICTOR F. FROELICHER
Institutions: Winston-Salem, NC, Palo Alto, CA
Results: Cardiorespiratory fitness (CRF) is a strong, independent mortality predictor among patients with and without cardiovascular disease (CVD). However, less is known about the protective effects of CRF among individuals with diabetes. Our aim was to investigate associations among CRF, diabetes, CVD, and all-cause mortality. Participants were 6,617 men without diabetes and 932 men with diabetes (mean age 59±11 years) in the Veterans Exercise Testing Study during 1987-2003. Subjects were classified according to CRF (METs) as low-fit (<5.0), moderate-fit (5.0-10.0), and high-fit (>10.0). The relation of CRF to mortality was assessed by Cox proportional hazards analyses adjusted for age, ethnicity, current smoking, hypertension, hyperlipidemia, and BMI. Vital status was determined as of December 31, 2004. During a mean follow-up of 8.1±4.7 (range, 1.0-17.7) years, a total of 1,637 patients (21.7%) died. Best predictors of mortality (hazard ratio [95% CI]), in descending order, were low-CRF (1.92 [1.72-2.15]), CVD (1.71 [1.52-1.91]), diabetes (1.35 [1.16-1.57]), and current smoking (1.32 [1.19-1.47). Compared to the high-fit reference group of normal subjects, mortality risk for patients with diabetes, CVD, and both diabetes and CVD was 3.8, 4.6, and 5.2 times higher for low-fit, and 1.0, 1.4, and 2.6 times higher for high-fit patients, respectively.[figure1]In this clinical cohort of veterans, high CRF eliminated the mortality risk of diabetes and cut mortality risk in half for those with both diabetes and CVD.